Objective To evaluate the single-use of laser photocoagulation (LP) and the combined-use of laser photocoagulation plus intravitreal triamcinolone (LP+IVTA) for diabetic macular edema (DME) in terms of clinical therapeutic effect and safety. Methods Such databases as The Cochrane Library, Medline, Embase, CBM, CNKI and Wanfang Data were searched from the date of their establishment to September 2011, and the references of all included studies were also traced, so as to identify the randomized controlled trials (RCTs) on LP vs. LP+IVTA for DME. The quality assessment and data extraction were conducted in accordance with the Cochrane Handbook 5.0 by two reviewers independently, and then Meta-analyses were conducted using RevMan 5.0 software. Results Ten RCTs involving 525 ill eyes were included, and all of them were classified as Grade B in methodological quality. Results of meta-analysis showed that: at the end of follow-up, there were significant differences between the LP+IVTA group and the LP group in the best corrected visual acuity (BCVA) (RR=–0.14, 95%CI –0.20 to –0.08, Plt;0.000 01), and the central macular thickness (CMT) (RR=–56.78, 95%CI –84.03 to –29.54, Plt;0.000 1). In comparison with the LP group, there were more people in the LP+IVTA group who needed to be treated for their elevated intraocular pressure and to have surgery for the progression of cataract. But no significant difference was found between the two groups in vitreous hemorrhage, retinal detachment, retinal vein occlusion and macular epiretinal membrane. Conclusion Current evidence of clinical research shows that the LP+IVTA is superior to LP in reducing macular edema and improving vision in the treatment of diabetic macular edema, but it may also result in a high incidence of elevated intraocular pressure and cataract. Because the methodological quality limitation of included studies may affect the authenticity of outcomes, this conclusion has to be further proved by more high-quality and large-scale clinical trials.
ObjectiveTo observe the efficacy of intravitreal injection of conbercept (IVC) combined with subthreshold micropulse laser photocoagulation (SMLP) in the treatment of diabetic macular edema (DME). MethodsA randomized controlled trial. From December 2020 to January 2022, 100 patients (100 eyes) with DME diagnosed by examination in Shanxi Aier Eye Hospital were included in the study. The patients were randomly divided into IVC group (50 eyes) and IVC+SMLP group (50 eyes). All the eyes were treated with IVC once a month for 3 times, and the eyes in IVC+SMLP group were treated with SMLP within 2 weeks after IVC. All affected eyes were examined by best corrected visual acuity (BCVA), which was statistically converted to logarithm of the minimum angle of resolution (logMAR) visual acuity. The central macular thickness (CMT) was measured by optical coherence tomography. Before the treatment, the logMAR BCVA of patients in IVC group and IVC+SMLP group were 0.56±0.04 and 0.55±0.03, respectively. The CMT were (437.36±11.35) μm and (434.58±10.88) μm, respectively. There was no significant difference in logMAR BCVA and CMT between the two groups (t= 0.476, 1.027; P＞0.05). The patients were followed up for 12 months after treatment. The times of IVC and the changes of BCVA and CMT were compared between the two groups. Independent sample t-test was used to compare the logMAR BCVA, CMT and times of IVC between groups. ResultsAfter 12 months treatment, the logMAR BCVA of IVC group and IVC+SMLP group were (241.63±29.79) μm and (240.47±30.46) μm, respectively. Compared with those before treatment, 12 months after treatment, the BCVA of the two groups increased significantly (t=7.014, 5.608; P＜0.001), while CMT decreased significantly (t=8.126, 6.013; P＜0.001). There was no significant difference in BCVA and CMT between the two groups (t=0.835, 0.764; P＞0.05). The number of IVC in IVC group and IVC+SMLP group were (8.15±2.04) times and (5.91±1.80) times, respectively, and the difference was statistically significant (t=5.210, P＜0.001). ConclusionsBoth IVC+SMLP and IVC alone can effectively reduce CMT and increase BCVA in patients with DME. Combination therapy can reduce the number of IVC.
Diabetic macular edema (DME) is the most threatening complication of diabetic retinopathy that affects visual function, which is characterized by intractability and recurrent attacks. Currently, the clinical routine treatments for DME mainly include intravitreal injection, grid laser photocoagulation in the macular area, subthreshold micropulse laser, periocular corticosteroid injection, and vitrectomy. Although conventional treatments are effective for some patients, persistent, refractory, and recurrent DME remains a clinical challenge that needs to be urgently addressed. In recent years, clinical studies have found that certain combination therapies are superior to monotherapy, which can not only restore the anatomical structure of the macular area and effectively reduce macular edema but also improve visual function to some extent while reducing the number of treatments and the overall cost. This makes up for the shortcomings of single treatment modalities and is highly anticipated in the clinical setting. However, the application of combination therapy in clinical practice is relatively short, and its safety and long-term effectiveness need further exploration. Currently, new drugs, new formulations, and new therapeutic targets are still under research and development to address different mechanisms of DME occurrence and development, such as anti-vascular endothelial growth factor agents designed to anchor repetitive sequence proteins with stronger inhibition of vascular leakage, multiple growth factor inhibitors, anti-inflammatory agents, and stem cell therapy. With the continuous improvement of the combination application of existing drugs and treatments and the development of new drugs and treatment technologies, personalized treatment for DME will become possible.
Objective To observe and analyze the risk factors of secondary intraocular hypertension in diabetic macular edema (DME) patients after treatment with dexamethasone vitreous cavity implant (DEX). MethodsA retrospective observational study. A total of 352 patients with type 2 diabetes mellitus (T2DM) secondary macular edema diagnosed by ophthalmic examination and treated with DEX in Department of Ophthalmology of Harbin 242 Hospital from January 2016 to March 2022 were included in the study. Among them, 221 were males and 131 were females, with the mean age of (55.56±8.09) years. There were 194 patients with disseminated macular edema, 158 patients with cystoid macular edema. All patients underwent vitreous cavity implantation of DEX. Intraocular pressure (IOP) was measured once a month for 3 months after treatment, with IOP over than 25 mm Hg (1 mm Hg=0.133 kPa) or higher than 10 mm Hg from baseline as secondary intraocular hypertension. The relevant clinical data were collected, and the risk factors of secondary intraocular hypertension in DME patients after DEX treatment were analyzed by binary logistic regression. ResultsAmong 352 patients, 116 patients (32.95%, 116/352) were in the intraocular hypertension. Among them, 29 patients (25.00%, 29/116), 69 patients (59.48%, 69/116) and 18 patients (15.52%, 18/116) occurred intraocular hypertension at 1, 2 and 3 months after treatment, respectively. Compared with the normal IOP group, the IOP in the intraocular hypertension group increased significantly at 1, 2 and 3 months after treatment, with statistical significance (t=10.771, 21.116, 13.761; P＜0.001). Compared with normal IOP group, the patients in the intraocular hypertension group had younger age (t=6.967), longer duration of diabetes (t=5.950), longer axial length (AL) (t=14.989), higher proportion of DME grade 3 (Z=6.284), higher proportion of DEX implantation in pars plana (χ2=23.275), and higher HbA1c level (t=10.764), the differences were statistically significant (P＜0.05). Logistic regression analysis showed that longer AL [odds ratio (OR)=1.428, 95% confidence interval (CI) 1.054-1.934], DEX implantation in pars plana (OR=1.358, 95%CI 1.063-1.735), and higher HbA1c (OR=1.702, 95%CI 1.225-2.366) were the risk factors for secondary intraocular hypertension in DME patients after DEX treatment (P＜0.05), older age was a protective factor (OR=0.548, 95%CI 0.380-0.789, P＜0.05). ConclusionsLong AL, DEX implantation in pars plana and high HbA1c are the risk factors for secondary intraocular hypertension after DEX treatment in DME patients, older age is a protective factor.
Objective To observe the clinical effect of vitrectomy, inner limiting membrane (ILM) peeling, subretinal injection of compound electrolyte intraocular irrigation solution (CEIIS) and conbercept in the treatment of diabetic macular edema (DME) with hard exudate (HE) (DME-HE). MethodsA prospective clinical study. Thirty-three patients with DME-HE diagnosed by examination in Weifang Eye Hospital from June 2020 to February 2022 were included in the study. Among them, there were 15 males (16 eyes) and 18 females (20 eyes), with the mean age of (62.00±6.54) years. All patients underwent the examinations of best corrected visual acuity (BCVA), scanning laser ophthalmoscope, optical coherence tomography (OCT), and multifocal electroretinography (mf-ERG). Snellen visual acuity chart was used for BCVA examination, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for statistic analysis. Macular foveal retinal thickness (CMT) and macular volume (MV) were measured by OCT. The 1 ring P1 wave amplitude density was measured by mf-ERG. The patients were randomly divided into group A and group B, with 17 patients (18 eyes) and 16 patients (18 eyes), respectively. There were no significant differences in age, logMAR BCVA, HE area, CMT, MV, and 1 ring P1 wave amplitude density between the two groups (t=0.403, 0.972, 0.291, 0.023, －0.268, －0.206; P＞0.05). Group A was treated with vitrectomy, ILM peeling, and subretinal injection of CEIIS and conbercept (combined therapy). Group B was treated with intravitreal injection of conbercept (IVC). Follow-up was 12 months after treatment. The changes of BCVA, HE area, CMT, MV, 1 ring P1 wave amplitude density were compared between groups and groups after treatment. The times of injection and complications after treatment were observed. Independent sample t test was used for comparison between the two groups. ResultsAt 12 months after treatment, compared to before treatment, there were significant differences in logMAR BCVA (F=14.837), HE area (χ2=94.522), CMT (χ2=199.212), MV (χ2=81.914) and 1 ring P1 wave amplitude density (F=8.933) in group A (P＜0.05); there were significant differences in CMT (F=5.540) and MV (F=7.836) in group B (P＜0.05). Compared between the two groups, logMAR BCVA: 1 week and 6 and 12 months after treatment, the difference was statistically significant (t=2.231, －2.122, －3.196; P＜0.05); HE area: except 1 week after treatment, there were statistically significant differences at other times after treatment (t=－2.422, －3.107, －3.540, －4.119; P＜0.05). CMT, MV, 1 ring P1 wave amplitude density: 12 months after treatment, the differences were statistically significant (t=－2.653, －2.455, 2.204; P＜0.05). During the follow-up period, the injection times of group A and group B were (3.06±1.89) and (5.56±2.04), respectively, and the difference was statistically significant (t=－3.815, P＜0.05). Macular hole and vitreous hematoma were found in 1 eye in group A and 1 eye in group B. ConclusionVitrectomy, ILM peeling, subretinal injection of CEIIS and conbercept to treat DME-HE can effectively remove HE, alleviate macular edema, improve BCVA, and reduce CMT and MV. Combination therapy can reduce the number of IVC re-treatments.
Proliferative diabetic retinopathy is a serious complication of diabetes in the eye that can lead to severe vision loss or even complete vision loss. In recent years, with the rapid development of surgical equipment and fundus examination technology, the indications for pars plana vitrectomy based surgical treatment have been expanded, surgical improvement and application, combined application of drugs, such as anti-vascular endothelial growth factor drugs, glucocorticoids, and surgical evaluation have made new progress. Surgical evaluation based on imaging can continuously monitor patients' eye conditions before, during and after surgery, and clinicians can choose different surgical plans and timing for different patients, which can help reduce patients' pain and achieve better visual outcomes.